From the Guidelines
To manage GERD effectively, a stepwise diagnostic approach should be used to identify the mechanisms driving symptoms, and patients should receive education on GERD pathophysiology and lifestyle modifications, with a shared decision-making model. The management of GERD should start with lifestyle modifications, including weight loss, avoiding trigger foods, eating smaller meals, not eating 2-3 hours before bedtime, elevating the head of the bed by 6-8 inches, and quitting smoking 1.
- For medication therapy, a 4- to 8-week trial of single-dose proton pump inhibitor (PPI) therapy is considered safe and appropriate for patients with typical reflux symptoms and no alarm symptoms, with escalation to twice-a-day dosing or switching to a more potent acid suppressive agent if symptoms persist 1.
- Symptom response should prompt PPI titration to the lowest effective dose, and when long-term PPI therapy is planned, objective reflux testing should be offered to establish a diagnosis of GERD and a long-term management plan 1.
- If symptoms don't improve after 4-8 weeks of PPI therapy, or if alarm symptoms are present, further evaluation, including endoscopy, should be considered to rule out complications like Barrett's esophagus or esophageal cancer 1.
- A precision approach to escalation of management is suggested for patients with ongoing symptoms despite these measures, which should be driven by integrity of the anti-reflux barrier, presence of visceral hypersensitivity and hypervigilance, confirmation of PPI refractory-GERD, symptom profile, body mass index, and esophageal (as well as gastric) motor function 1. Key considerations in the management of GERD include:
- Patient education and shared decision-making
- Lifestyle modifications
- Stepwise diagnostic approach
- Appropriate use of PPI therapy
- Objective reflux testing for long-term management
- Precision approach to escalation of management for patients with ongoing symptoms.
From the FDA Drug Label
1.4 Treatment of Symptomatic Gastroesophageal Reflux Disease (GERD) Omeprazole delayed-release capsules are indicated for the treatment of heartburn and other symptoms associated with GERD for up to 4 weeks in patients 2 years of age and older. 1.7 Treatment of Symptomatic Gastroesophageal Reflux Disease (GERD) Lansoprazole delayed-release capsules are indicated for short-term treatment in adults and pediatric patients 12 to 17 years of age (up to eight weeks) and pediatric patients one to 11 years of age (up to 12 weeks) for the treatment of heartburn and other symptoms associated with GERD
Gerd management can be achieved with:
- Omeprazole for up to 4 weeks in patients 2 years of age and older
- Lansoprazole for short-term treatment in adults and pediatric patients 12 to 17 years of age (up to eight weeks) and pediatric patients one to 11 years of age (up to 12 weeks) 2 3
From the Research
Gerd Management
- Gastroesophageal reflux disease (GERD) can be managed with a combination of lifestyle modifications and medication therapy 4
- Proton pump inhibitors (PPIs) are commonly used to treat GERD, with studies showing that they are effective in healing reflux esophagitis and controlling symptoms 5, 6, 7, 8
- The choice of PPI may not matter, as studies have shown that different PPIs have similar potency and efficacy 6
- Combination therapy with PPIs and histamine(2) receptor antagonists may be beneficial for patients who do not respond to standard PPI therapy, particularly for nocturnal acid control 5, 7
- Lifestyle modifications, such as weight loss and dietary changes, can also play an important role in managing GERD symptoms 4
- Nursing education and patient advocacy can help promote health behaviors and improve outcomes for patients with GERD 4
Medication Therapy
- PPIs, such as omeprazole, lansoprazole, and pantoprazole, are effective in healing reflux esophagitis and controlling symptoms 5, 6, 8
- Histamine(2) receptor antagonists, such as ranitidine, may be used in combination with PPIs for nocturnal acid control 5, 7
- The efficacy of combination therapy with PPIs and histamine(2) receptor antagonists has not been proven to correlate with improvement of GERD symptoms 5
Lifestyle Modifications
- Weight loss and dietary changes can help manage GERD symptoms 4
- Avoiding trigger foods and eating smaller, more frequent meals can help reduce symptoms 4
- Registered nurses can play an instrumental role in promoting health behaviors and providing education on lifestyle modifications for patients with GERD 4